Electroencephalogram findings in 10 patients with post-stroke epilepsy:A retrospective study

BACKGROUND Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease.Long-term seizures can seriously affect the prognosis and quality of life of patients.Electroencephalogram(EEG)is the simplest way to diagnose epilepsy,and plays an important role in predicting seizures and guiding medication.AIM To explore the EEG characteristics of patients with post-stroke epilepsy and improve the detection rate of inter-seizure epileptiform discharges.METHODS From January 2017 to June 2020,10 patients with post-stroke epilepsy in our hospital were included.The clinical,imaging,and EEG characteristics were collected.The stroke location,seizure type,and ictal and interictal EEG manifestations of the patients with post-stroke epilepsy were then retrospectively analyzed.RESULTS In all 10 patients,epileptiform waves occurred in the side opposite to the stroke lesion during the interictal stage;these manifested as sharp wave,sharp-wave complex,or spike discharges in the anterior head lead of the side opposite to the lesion.CONCLUSION In EEG,epileptiform waves can occur in the side opposite to the stroke lesion in patients with post-stroke epilepsy.

Mechanism of acupuncture for limb spasm of post-stroke spasticity based on GABA and BDNF/Trkb-KCC2 signaling pathway

Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.

Early screening for post-stroke depression and its effect on functional outcomes, quality of life, and mortality: A meta-analysis

BACKGROUND Post-stroke depression(PSD)is a common and debilitating condition affecting stroke survivors,significantly impacting their recovery and overall quality of life.AIM To assess the effects of early PSD screening on functional outcomes,quality of life,and mortality.METHODS From an initial pool of 1065 articles,6 studies met the inclusion criteria and were selected for analysis.Functional outcomes were measured using the functional independence measure(FIM).RESULTS The analysis revealed a significant improvement in FIM scores for a PSD scree-ning group compared to controls[standardized mean difference(SMD)=8.90,95%confidence interval(CI):4.65-13.15,P<0.01].Quality of life was assessed using the Stroke-Specific Quality of Life Scale,with the screening group showing significantly higher scores(SMD=20.83,95%CI:15.27-26.38,P<0.01).Mortality analysis indicated a reduction in five-year mortality rates for the PSD screening group.CONCLUSION Early PSD screening enhances functional recovery,improves quality of life,and reduces mortality rates in stroke survivors.Thus,integrating PSD screening into routine stroke care improves long-term outcomes for patients.

Impact of extended nursing model after multi-disciplinary treatment on young patient with post-stroke

BACKGROUND Stroke has become one of the most serious life-threatening diseases due to its high morbidity,disability,recurrence and mortality rates.AIM To explore the intervention effect of multi-disciplinary treatment(MDT)extended nursing model on negative emotions and quality of life of young patients with post-stroke.METHODS A total of 60 young stroke patients who were hospitalized in the neurology department of our hospital from January 2020 to December 2021 were selected and randomly divided into a control group and an experimental group,with 30 patients in each group.The control group used the conventional care model and the experimental group used the MDT extended nursing model.After the inhospital and 3-mo post-discharge interventions,the differences in negative emotions and quality of life scores between the two groups were evaluated and analyzed at the time of admission,at the time of discharge and after discharge,respectively.RESULTS There are no statistically significant differences in the negative emotions scores between the two groups at admission,while there are statistically significant differences in the negative emotions scores within each group at admission and discharge,at discharge and post-discharge,and at discharge and post-discharge.In addition,the negative emotions scores were all statistically significant at discharge and after discharge when compared between the two groups.There was no statistically significant difference in quality of life scores at the time of admission between the two groups,and the difference between quality of life scores at the time of admission and discharge,at the time of discharge and post-discharge,and at the time of admission and post-discharge for each group of patients was statistically significant.CONCLUSION The MDT extended nursing mode can improve the negative emotion of patients and improve their quality of life.Therefore,it can be applied in future clinical practice and is worthy of promotion.

P25/CDK5-mediated Tau Hyperphosphorylation in Both Ipsilateral and Contralateral Cerebra Contributes to Cognitive Deficits in Post-stroke Mice

Objective Post-stroke cognitive impairment(PSCI)develops in approximately one-third of stroke survivors and is associated with ingravescence.Nonetheless,the biochemical mechanisms underlying PSCI remain unclear.The study aimed to establish an ischemic mouse model by means of transient unilateral middle cerebral artery occlusions(MCAOs)and to explore the biochemical mechanisms of p25/cyclin-dependent kinase 5(CDK5)-mediated tau hyperphosphorylation on the PSCI behavior.Methods Cognitive behavior was investigated,followed by the detection of tau hyperphosphorylation,mobilization,activation of kinases and/or inhibition of phosphatases in the lateral and contralateral cerebrum of mice following ischemia in MACO mice.Finally,we treated HEK293/tau cells with oxygen-glucose deprivation(OGD)and a CDK5 inhibitor(Roscovitine)or a GSK3βinhibitor(LiCl)to the roles of CDK5 and GSK3βin mediating ischemia-reperfusion-induced tau phosphorylation.Results Ischemia induced cognitive impairments within 2 months,as well as causing tau hyperphosphorylation and its localization to neuronal somata in both ipsilateral and contralateral cerebra.Furthermore,p25 that promotes CDK5 hyperactivation had significantly higher expression in the mice with MCAO than in the shamoperation(control)group,while the expression levels of protein phosphatase 2(PP2A)and the phosphorylation level at Tyr307 were comparable between the two groups.In addition,the CDK5 inhibitor rescued tau from hyperphosphorylation induced by OGD.Conclusion These findings demonstrate that upregulation of CDK5 mediates tau hyperphosphorylation and localization in both ipsilateral and contralateral cerebra,contributing to the pathogenesis of PSCI.

“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”:Commentary

In this commentary,we summarize some of the key points of the original paper“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”and offer support for the proposed results.Specifically,we address how early percutaneous endoscopic gastrostomy(PEG)tube placement may reduce hospital length of stay and costs.We also discuss topics related to the article including PEG weaning and post-stroke nutritional formulation.However,we note that concerns purported by previous studies that early PEG placement may worsen outcomes are not fully addressed,and further research is needed.

Perspectives on multidimensional assessment of post-stroke sequelae: fromclinimetrics to holism

In this work,we intended to connect clinimetrics with holism in traditional Chinese medicine towards multidimensional assessment of post-stroke sequelae in real-world setting,as a bridge between inheritance and innovation.Firstly,a systematic search of current evidence that supported integrated treatment of traditional Chinese and Western medicine for post-stroke sequelae sufferers was performed.Secondly,on the basis of available evidence,we presented couples of implications.Lastly,as psychosomatic perspective is one of the main academic paradigms of traditional Chinese medicine holism,we chiefly proposed comprehensive assessment for both motor and non-motor severities to probably match consonance with traditional Chinese medicine practice that treats psycho-/somatic-complains simultaneously.

Clinical Study of Acupuncture Combined with Emotional Intervention in Patients with Post-Stroke Depression

Objective:To investigate the clinical efficacy of acupuncture combined with emotional intervention in patients with post-stroke depression(PSD).Methods:A total of 100 patients with PSD who met the inclusion criteria were randomly divided into an experimental group(50 cases)and a control group(50 cases)using the random number table method,and the enrollment was in order of admission time.The control group used conventional treatment of oral antidepressant Deanxit tablets(0.5 mg flupenthixol+10 mg melitracen)with the dose appropriately adjusted according to the patient’s medication effect,and modern rehabilitation treatment given selectively according to the patient’s condition.The experimental group had similar treatment as the control group with the addition of traditional Chinese medicine(TCM)acupuncture combined with emotional intervention.The application effects of both groups before and after treatment were verified using the Hamilton Depression Rating Scale(Ham-D),National Institutes of Health Stroke Scale(NIHSS),and Activities of Daily Living(ADL),serotonin levels were measured,and statistical analyses were carried out.Results:The total effective rate of patients in the experimental group was significantly higher than that in the control group,and the Ham-D score,NIHSS score,ADL score,and serotonin level after treatment were significantly higher than those in the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusion:For patients with PSD,adding TCM acupuncture with emotional intervention on top of conventional treatment significantly improve the clinical efficacy and better improve the daily life ability of patients.

CLINICAL STUDY ON THE TREATMENT OF POST-STROKE DEPRESSION WITH ELECTROACUPUNCTURE OF “NIWAN BAZHEN” POINTS

Objective To observe the therapeutic effect of electroacupuncture （EA） of ＂Niwan Bazhen＂ points in the treatment of post-stroke depression. Methods A total of 66 post-stroke depression patients were randomized into treatment group （EA＋oral administration of Prozac-20, n =31 ） and control group （o- ral administration of Prozac-20, 20 mg/d, 28 days altogether, n =30）. For patients of treatment group, EA （2/100 Hz, a tolerable stimulation strength） was applied to ＂Niwan Bazhen＂ points [Baihui （百会 GV20）, etc. ] for 30 min, once daily, （except weekends） continuously for one month. Halmiton Rating Scale （HAMD） for Depression and Chinese Scale for Stroke （CSS） were used to evaluate the therapeutic effect. Results After the treatment, of the 30 and 31 cases in control and treatment groups, 4 and 6 were cured, 10 and 14 experienced marked improvement.in their symptoms, 6 and 7 had an improvement, 6 and 4 failed, with the cure＋ markedly effective rates being 46.7% and 64.5% respectively. The therapeutic effect of treatment group was significantly superior to that of control group （ P〈0.05）. The decreased values of both HAMD and C,,SS of treatment group were remarkably lower than those of control group （P〈0.01,0.05） . Conclusion EA of ＂Niwan Bazhen＂ points is an effective remedy for post-stroke depression.

Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction： a diffusion tensor tractography imaging study

Many studies using diffusion tensor tractography（DTT） have demonstrated that injury of the spinothalamic tract（STT） is the pathogenetic mechanism of central post-stroke pain（CPSP） in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients（patients 1 and 2） and three patients（patients 3, 4, and 5）, respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient（patient 2）. Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.

miR-137, a new target for post-stroke depression?

Expression of miR-137 is downregulated in brain tissue from patients with depression and suicidal behavior, and is also downregulated in peripheral blood from stroke patients. However, it is not yet known if miR-137 acts as a bridge between stroke and depression. To test this, we used middle cerebral artery occlusion and chronic mild stress to establish a post-stroke depression model in rats. Compared with controls, we found significantly lower miR-137 levels in the brain and peripheral blood from post-stroke depression rats. Injection of a miR-137 antagonist into the brain ventricles upregulated miR-137 levels, and improved behavioral changes in post-stroke depression rats. Luciferase assays showed miR-137 bound to the 3＇UTR of Grin2A, regulating Grin2A expression in a neuronal cell line. Grin2A gene overexpression in the brain of post-stroke depression rats, no- ticeably suppressed the inhibitory effect of miR-137 on post-stroke depression. Overall, our results show that miR-137 suppresses Grin2A protein expression through binding to Grin2A mRNA, thereby exerting an inhibitory effect on post-stroke depression. Our results offer a new therapeutic direction for post-stroke depression.

The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine

The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and les- sen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke depression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distilled water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining results demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules increased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein expression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expression in hip pocampi of rats with post-stroke depression, and exert antidepressant effects.

Apolipoprotein E polymorphisms increase the risk of post-stroke depression

Recent reports have shown that apolipoprotein E （APOE） polymorphisms are involved in neurodegenerative disease. However, it is unclear whether APOE affects post-stroke depression. Accordingly, we hypothesized that APOE polymorphisms modify the risk of post-stroke depression. Here, we performed a hospital-based case-control study （including 76 cerebral infarction cases with post-stroke depression, 88 cerebral infarction cases without post-stroke depression, and 109 controls without any evidence of post-stroke depression or cerebral infarction） to determine possible association between APOE rs429358 and rs7412 polymorphisms and risk of post-stroke depression. Our findings show no difference among the groups with regards genotype distribution of the rs7412 polymorphism. In contrast, APOE genotypes with rs429358-C alleles increased the risk of post-stroke depression. Further, the rs429358 polymorphism was associated with significantly decreased regional cerebral blood flow values in the left temporal lobe of post-stroke depression cases. Additionally, the rs429358 polymorphism was not only associated with depression severity, but with increasing serum levels of total cholesterol. These resuits suggest that the APOE rs429358 polymorphism is associated with increased risk of developing post-stroke depression, and that APOE rs429358-C allele genotypes may be detrimental to recovery of nerve function after stoke. Indeed, these findings provide clinical data for future post-stroke depression gene interventions.

Electroacupuncture at the Wangu (GB 12) acupoint suppresses expression of inflammatory factors in the hippocampus and frontal lobe of rats with post-stroke depression

Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.

Metabolic changes of prefrontal cerebral lobe,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

BACKGROUND： Proton magnetic resonance spectroscopy （IH-MRS） non-invasively detects changes in chemical substances in the brain, which reflects the pathological metabolism.OBJECTIVE： To investigate changes in N-acetyl-aspartate （NAA）, choline （Cho）, creatine （Cr）, and myoinositol （MI） in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression （PSD） using ^1H-MRS. DESIGN： A case control study. SETTING： The First Affiliated Hospital of the Dalian Medical University. PARTICIPANTS： A total of 38 patients with stroke （28 male and l0 female patients, aged 40 to 79 years） were selected from the Department of Neurology, 1st Affiliated Hospital, Dalian Medical University, from February to October in 2004. All subjects met the DSM-IV criteria for cerebrovascular disease and depression. The degree of depression was defined according to Hamilton criteria. 38 patients with PSD were divided into two groups according to the time after ischemia, 20 patients in the acute group with less than 10 days after ischemic attack （mild： 16 patients, moderate/severe： 4 patients） and 18 patients in the chronic group with more than l l days after ischemic attack （mild： 15 patients, moderate/severe： 3 patients）. Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group. The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht, and each participant signed an informed consent form. METHODS： Spectra were acquired by multi-voxel point-resolved spectroscopy （PRESS） sequence with GE signal.5T MR/i, localized in prefrontal cerebral lobe and cerebellum. Values of NAA, Cho, MI, and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS 11.5. MAIN OUTCOME MEASURES： Metabolite concentration in different brain regions of interest. Difference in metabolites between distinctly graded PSD patients and control subjects. Exclusion of age-effects on metabolites. RESULTS： Metabolite concentrations of different brain regions： A significant rise in the Cho/Cr ratio was detected in the acute and chronic group compared to the control group. The ratio change was more significant in the acute group （P 〈 0.05）. There was no significant difference between these three groups for other metabolites detected by IH-MRS in the right frontal white matter, bilateral frontal grey matter, and cerebellum （P 〉 0.05）. Comparison of metabolite levels among differently graded PSD patients and control subjects： a significant increase in the Cho/Cr ratio was detected in the left frontal white matter compared to the control group （P 〈 0.05）. There was no significant difference in age between patients in the stroke groups and the control group （P 〉 0.05）, and similarly, there was no significant correlation between age and absolute or relative values in the control group （P 〉 0.05）. CONCLUSION： Abnormalities of frontal lobe in PSD were located in the white matter. There was early abnormality of metabolic substance in PSD.

Clinical Observation of Huatanjieyu Granule in the Treatment of Post-stroke Depression

[Objectives]To observe the clinical effect of Huatanjieyu granule on patients with post-stroke depression.[Methods]Total 76 patients with confirmed post-stroke depression were randomly divided into two groups(treatment group and control group)according to the double-blind principle.The treatment group(38 cases)was treated with Huatanjieyu granule combined with escitalopram,and the control group(38 cases)was treated with escitalopram alone.The course of treatment was 6 weeks.Through clinical efficacy,Hamilton Depression Scale(HAMD)and Treatment Emergent Symptom Scale(TESS)scores were compared,and blood,liver function,renal function and electrocardiogram were examined.[Results]The scores of HAMD and TESS in patients with post-stroke depression were significantly decreased by Huatanjieyu granule,and there were no obvious side effects.The total effective rate was 92.1%in the treatment group and 76.3%in the control group.There was significant difference between the two groups(P<0.01).[Conclusions]Huatanjieyu granule was effective in the treatment of post-stroke depression with little side effects and was easy to be accepted by patients.

Recent advances in the treatment of post-stroke aphasia

Aphasia is an impairment of language use following brain damage. There is no consensual definition of aphasia beyond this general description （Code and Petheram, 2011）. In a more restricted defini- tion, however, aphasia is an impairment of linguistic processing at the phonological, morphological, lexical semantic or syntactic level which is usually caused by lesions of the left cerebral hemisphere. This impairment can affect language reception and expression depending on the various aphasic syndromes （McNeil and Pratt, 2001）. Aphasia results in restrictions in those activities of daily living which rely on communication.

CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 mg once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to χ2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.

Efficacy of early intervention of motor relearning program on post-stroke hemiplemia:A randomized controlled observation

BACKGROUND： Previous studies believed that the effect of rehabilitation training within 6 months after stroke （early rehabilitation training） is usually unsatisfactory. The rehabilitation training when acute stroke is stabilized may be better for the recovery of limb function. OBJECTIVE： To observe the effects of the rehabilitation training of motor relearning program plus Bobath technique on the motor function of limbs, nerve function and activities of daily life （ADL） in patients with acute stroke hemiplegia. DESIGN： A randomized controlled observation SETTING： Department of Neurology, Yaan People＇s Hospital PARTICIPANTS： A total of 150 patients with acute post-stroke hemiplegia were selected from the Department of Neurology, Yaan People＇s Hospital from March 2000 to October 2002. The patients were all accorded with the diagnostic standards about stroke set by the Fifth National Academic Meeting for Cerebrovascular Disease （1996）, confirmed by CT and MRI, and they were all informed with the interventions and the items of evaluation. The enrolled patients were randomly divided into training group （n=78） and control group （n=72） at admission. METHODS ： ① Interventions： All the patients were given routine treatments for stroke, including managin blood pressure, maintaining the balance of hydrolyte and electrolure, reducing intracranial pressure by dehydration, and venous injection of citicoline, besides those in the training group received rehabilitation training by motor relearning program and Bobath technique. The rehabilitation training began after the vital signs became stable within 24 hours to 3 days after attack for the patients with cerebral infarction and 48 hours to 5 days after at- tack for those with cerebral hemorrhage respectively, three times a day in the morning, at noon and in the evening respectively, 30 minutes for each time, they were trained for 1 month. Lying position： The patients should keep the anti-spasm posture in the supine position, contralateral and ipsilateral lying positions, and the postures should be changed regularly; The patients should exercise each joint passively; turn the body over and move actively; They should also performed the bringing training, and the weight loading training for the affected upper limb. Sitting position： The patients should finish the conversion from a lying position to a sitting one independently. Standing position： The patients should finish the conversion from a sitting position to a standing one independently; They also took weight loading training for the affected lower limb. The walking training should be performed when the affected lower limb could support 2/3 of body mass. Walking training： In a standing position supported by the affected lower limb, the unaffected one stepped in small range forward and backward; Each process of balancing and controlling standing position was trained by supporting the body mass by the affected lower limb; In swinging position, the independent movement of the ipsilateral knee joint was trained in alternation of flexion and extension. ② Evaluation of limb function, ADL and nerve function： The motor function of the affected limb was evaluated with the Fugl-Meyer assessment （FMA）, the total score of the motor function of upper and lower limbs was 100 points, the higher the score, the better the limb function. ADL were assessed with the modified Barthel index （MBI）, the total score was 100 points, the higher the score, the better the independence and the smaller the dependence. The severities of neurological deficit were assessed with neurological deficit score （NDS）, the total score ranged 0-45 points, the higher the score, the severer the neurological deficit. ③ Statistical analysis： The ttest was applied to compare the differences of the measurement data. MAIN OUTCOME MEASURES： The changes of nerve function, motor function and ADL in patients with post-stroke hemiplegia after motor relearning program training were observed. RESULTS： All the 150 patients with post-stroke hemiplegia were involved in the analysis of results. ① The scores of NDS, FMA and MBI before intervention in the training group were （25±9）, （23±23）, （20±16） points, which were close to those in the control group [（24±8）, （24±21）, （24±20） points, P 〉 0.05]. ② The NDS score after intervention in the training group was obviously lower than that in the control group [（10±7）, （18±9） points, t=4.07, P 〈 0.01], but the FMA and MBI scores were markedly higher than those in the control group [（72±28）, （80±24） points; （43±28）, （40±24） points, t=3.99, 6.50, P 〈 0.01]. CONCLUSION ： The comprehensive rehabilitation of motor relearning program plus Bobath technique at early period can remarkably improve the motor function of the affected limbs, nerve function and ADL in patients with post-stroke hemiplegia.

Role of Transcranial Direct Current Stimulation in the Management of Post-Stroke Depression

Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation;techniques;transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.